Learning in the Social Age. St Emlyn’s at #EMERGE10

This week I am in Edinburgh at the #EMERGE10 conference. This is a celebration of 10 years of the Emergency Medicine Research Group in Edinburgh. They are responsible for some of the most influential UK research work in emergency medicine, prehospital care and critical care over the last 10 years and it’s undoubtably the case that your current clinical practice will have been influenced by their work. The 10 year celebration is a chance to reflect on the journey and to bring together a really remarkable group of speakers and delegates at the Hub in Edinburgh. Several of the St Emlyn’s team are attending. Rick spoke on day 1, Dan and myself are here on day two.

I’ve been asked to talk on learning in the social age. This topic brings together a number of previous thoughts, ideas, blogs and podcasts from the team in a theme that describes how academics, educators and learners are adapting to a new world of technology and social interaction.

What is the social age?

The social age is a term orginally described by Julian Stodd. In essence it recognises that we are now in a age where the strongest influences on our practice and behaviours are those that are facilitated through technologically enabled interactions and discussion. Many of us still think that we exist in the digital age whereby our worlds are infuenced predominantly by the presence of technologies such as laptops, smartphones and the internet. These are of course essential building blocks of our lives, but our use and interaction with these technologies has changed dramatically over the last 10 years. For those of us old enough to remember the start of the internet it is clear that we were originally using technology as a replacement for traditional means of knowledge storage and retrieval. The internet in the early days was largely static beyond the use of email. In the modern age the technology is now the tool with which to facilitate communication and interaction between people, communities and organisations. Most importantly that communication and interaction is multi-directional.

The social age as described by Julian Stodd

These changes in how we communicate and interact have far reaching and profound consequences to how we live our lives, and in academic/educational terms about how we value and consume information and learning. We can see this through changes in how traditional models of research dissemination form as compared to how knowledge is increasingly discovered and shared in a social age.

The traditional model of publication is led by hierachy that requires a defined fliter between content creators (for example researchers and research groups) and consumers. that filter mechanism is usually the publiation and peer review process that uses defined experts to ensure that quality is maintained and that the ‘right’ message gets to the consumer. I won’t reiterate the well known concerns about peer-review here, only to say that it’s broken and doesn’t work, but the reality is that we are currently still wedded to this broken system. The point here is that there is an inbuilt filter mechanism that controls the flow of information and which creates a hierachical and restrictive access to the flow of information and thus learning.

In the technologically enhanced social age this restriction is neither necessary nor real. There is no reason why researchers cannot interact with consumers directly through self publication, social media and conversation. Such interactions can by dynamic and, if self published a pre and post review process similar to that seen in other academic fields such as physics and chemistry.

More significantly is the disruption and democratisation of what and how knowledge consumers are influenced. Social interactions enable a wide variety of sources to influence which extend beyond the traditional academic institutions. Consumers can access and interact with a range of other sources of influence some of which are outlined below.

Mavens: Subject matter experts who develop a reputation for dissemination of knowledge. It is thought that a relatively small number of healthcare social media users have a disproportionate influence on knowledge dissemination (see tweet from Helan Bevan below).

Experts: We all know what an expert is (or do we). The definition of what constitutes expertise in a social space may differ from traditional models. Accessibility, willingness to interact and reputation may have a powerful influence.

Satire: A new influence on research and education in social media settings is the growth of satire (and in some cases abusive) content that acts to denigrate, abuse and humiliate content creators.

Personalised learning networks: Similar to a collection of self selected Mavens who are organsed to create and curate knowledge across a variety of fields.

Communities: We have seen the rise of organised online communities that share the same values, ideas and interests. Whilst these are at face value positive developments, they also risk becoming echo chambers for slef perpetuating views. Follow any airway debate for long enough and you will see what I mean.

Some leaders have much more influence than others which cannot be explained by their rank. About 5% of the leaders shape the perceptions of up to 90% of their colleagues in the leadership team (& they are more likely to be introverts): https://t.co/QMUHDIbu3W By@JeppeHansgaard pic.twitter.com/YeujrEjIaF

The point here is that where we might previously have considered organisations and authorities to be in control of information and more importantly it’s perceived value, in the social age it is community and networks that define value, importance and the dissemination of knowledge.

This may be a great thing. We know that there is a significant problem with the speed of change in medicine; estimates of the time taken for good research to go from creation to bedside are in the order of 12-17 years. Clearly the social age has the potential to shorten that time for the good of patients and that’s no bad thing. However, we must also be cautious about how networks develop and communicate. The same principles that might reduce the knowledge translation gap are arguably the same principles that brought Donald Trump to power. His use of social networks to bypass traditional information filters, to create networks of like minded people and to assist topic specific Mavens is arguably a cautionary tale to academia and education.

The dangers of community over expertise

Why do we need to think about this now?

The way in which we interact with the world has dramatically changed with the increasing influence of technologies into our daily lives. In education terms we must recognise that the modern learner is different to the way in which senior educators such as myself begain their learning journies.

As a medical student and junior doctor the only decision aids available to me were the Oxford Handbook of Clinical Medicine and the BNF. I wore a labcoat with deep pockets to accomodate these texts, but in most other ways I had to remember a huge range of facts. My time at medical school was largely based around the idea of fact retention and retrieval, I was in effect a walking library. In contrast in the modern world the walking library concept is in many ways largely redundant. Although I do need to remember many things to do the day job, there is a lot of medical knowledge that now resides in my smartphone. An internet enabled smart[hone gives me access to all the facts and most of the support I could possibly need in practice. My skill as a modern day clinician is in understanding how to use those technologies to find, curate, link, evaluate and interpret information found through the use of digital and internet connected technologies.

I like to think of this as a shift from youthful endevours to become a walking library through to the modern day when my role is to be the librarian. This change is one of the reasons why we need to change the way that we interact with students and junior doctors who have grown up in a world where there is easy access to facts via mobile devices. The skills they require and the knowledge they have access is radically different to the generation I trained in.

We are also working in a age where our attention and interaction is a battleground for devices, apps, and content providers. The social media platforms such as facebook, twitter and snapchat are in competition for our attention and contain specific design elements to keep us connected as frequently as possible. As educators we are in competition with our audience, up against the combined forces of the digital giants and that is a battle that we unlikely to win. Our smartphones and tablets are awash with content designed to distract and engage and that is influencing how and even whether we can engage our learners. We, and our learners are arguably in a state of continuous partial attention where distractions and media constantly interrupt us.

Nick Smith conducted a survey with med students asking them how long an education youtube video would have to be before they even bothered to START it. For core content roughly 50% would tip over at 30-45 mins. For anything other than absolute core exam content that figure was between 5 and 15 mins. In other words we are living in a hyperdistracted world that forces us to adapt our content when transferring it online such that the medium works. Read more on how the medium influences our understanding of content here. The bottom line here is that we cannot simply transfer our traditional 30-60 min lecture on line as a video capture. Our learners will simply not engage with it.

Some academics baulk at the idea of the need to make educational interesting and engaging, preferring the notion that it’s not about the presentation, it’s about the content. This dichotomous argument is of course a fallacy. We would never argue that presentation is more important than content, but rather that presentation is vital to deliver content. You probably know this from attending good and bad conference presentations, but it’s also pervasive in our day to day media. Dr Ranj runs a popular children’s program that although aimed at pre-schoolers also recognises that parents watch along with their kids. Thus in creating content for children we can educate parents about common diseases and vaccinations. In the past even Disney has engaged with public health messages aimed at reducing disease.

In the UK we experiences this co-influence when filming Operation Ouch. A show that demonstrated the use of LAT gel, a substance for anaesthetising wounds that has been around for decades led to the multiple enquiries and a significant increase in manufacturing demand. The fact that the screening of a children’s show can influence ED practice across the UK is remarkable, and also a little concerning when considering how PEM consultants get their CPD.

The bottom line here is that good educators and researchers have always adopted techniques to engage with their communities to help disseminate and promote their messages. The only thing that is really new now is the means at our disposal with which to achieve this.

What does this mean for academics?

As this was a research based conference it seems right to focus on how the changes described above can be used to develop and enhance academic activities.

Hopefully, and if you’ve managed to get this far then you are convinced that the world is changing and that we may need to change alongside it. For academics I think this will influence how we interact with three related groups, content users, peer networks and individual publications.

Content users.

In some respects this is the relatively easy group. For researchers engaged in subjects that have a direct patient facing use then the audience is the end user. If we are to make our research meaningful then strategies that notify users as soon as possible, and in an accessible form (most journal articles are written in a dry and boring fashion) is clearly important. take the REVERT trial to improve the management of SVT patients in the ED. As a large, pragmatic randomised controlled trial with an important patient related outcome the audience needs to be everyone and anyone dealing with those patients. The traditional publication route is simply too slow and cumbersome and so enagaging with other networks, twitter, blogs, conferences, etc. is clearly the right strategy.

Peer/academic networks

This is more complex. A lot of research is not yet ready for clinical use and thus the audience is not the end user, but rather other researchers in the field and special interest groups. We must also be mindful that impact is an important consideration in determining the ‘worth’ of an academic career. Traditional models to determine this are based on journal impact factors, which like peer review, has been shown to be flawed in many respects. In a world where information flow is being disrupted by new technologies it is not surprising to see strategies to measure and rate these influence mechanisms.

A number of websites and programs now allow the impact of a researcher’s work to be quanitified using metrics based on publications and sharing through the internet. Some of these are shown and discussed below.

Google Scholar provides an online repository of publications and linked metrics such as an h-index to quanitify the scope and reach of an individual researcher. My page is shown below with my modest efforts for all to see. You can easily set up your own Google Scholar page using your Google account details and then choose to make it public, or not.

Research Gate and Academia.edu have are specifically aimed at creating research networks for researchers. Described as facebook for academics they combine a document and project repository together with an option to find, follow and interact with other researchers. Again they incoporate metrics of worth, but these are influenced by activity within the program and thus it is possible to influence rankings by spending more time online (and therefore not doing proper work).

Individual Publications.

One of my frustrations as an author and journal editor is that in the past there has been no real way to determine whether anyone actually reads what we publish. There is the proxy measure of impact factor and distribution/subscriber data but these are poor measures of whether readers interact with the content. More recently it has become possible to track electronic interactions with published content. Publishers have been looking at this data for some time, for example by looking at downloads from journal websites. Similarly bloggers have used web data to determine who, where and how often content is accessed.

A more independent and broader analysis of the impact of individual papers has been attempted through the use of metrics such as Alt-Metrics and PlumX which combine evidence of usage based on social media interactions (twitter, Mendely, Blogs, news sites etc.). This is an attempt to quantify the scope and reach of publications which may more accurately reflect influence.

Whether it does or does not is as yet unclear. There is some evidence that papers in more socially enabled journals get more subsequent citations and our anecdtotal data suggests that this is the case. We are also seeing researchers linking with social media experts to promote and disseminate their findings. The independence of bloggers and social media influencers is unclear in these matters and there is at least one UK based site that proposed to use this as a commercial business strategy by taking payments to promote papers. The original model of #FOAMed based sites could thus be manipulated and compromised in the future.

The work required to engage with these programs needs to be carefully considered. At the moment there is an inconsistency in whether

Summary

A long blog post that brings together a whole range of ideas and concepts that we have talked about on the blog for several years. My take home points is really that we are in the social age, and that means that we have to do things differently if we want our message to be heard and understood. Quite what that means in a fast moving, technologically enhanced world is not entirely clear, but despite that I’m sure that it will be different to the environment I learned in.

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Posted by Simon Carley

Professor Simon Carley MB ChB, PGDip, DipIMC (RCS Ed), FRCS (Ed)(1998), FHEA, FAcadMed, FRCEM, MPhil, MD, PhD is Creator, Webmaster, owner and Editor in Chief of the St Emlyn’s blog and podcast. He is Professor of Emergency Medicine at Manchester Metropolitan University and a Consultant in adult and paediatric Emergency Medicine at Manchester Foundation Trust. He is co-founder of BestBets, St.Emlyns and the MSc in emergency medicine at Manchester Metropolitan University. He is an Education Associate with the General Medical Council and is an Associate Editor for the Emergency Medicine Journal. His research interests include diagnostics, MedEd, Major incidents & Evidence based Emergency Medicine. He is verified on twitter as @EMManchester